Initial Notification Report Form

EPA National Volatile Organic Compound Emission Standards for

Consumer Products

A one-time submission of this form to the appropriate Regional Office of the U.S. Environmental Protection Agency is required under CFR

Section 59.209(d) by all regulated entities as defined under CFR Section 59.202 by December 10, 1998 or within 30 days of becoming a

regulated entity under the rule. See back of this form for relevant rule sections and addresses of EPA Regional Offices.

Company Name __________________________________________________________________________________

Certifying Company Official

Submission Date _______________ ____, 19____

Name________________________________________________

Title ________________________________________________

Signature ____________________________________________

Address ______________________________________________

_____________________________________________________

Phone Number _______/_______/___________

Fax Number _______/_______/___________

E-Mail Address (optional) __________________@__________________._______

Product Categories Subject to CFR Section 59.203 for which the company is currently the regulated entity. (See

Definitions at CFR Section 59.202.) Check all that apply.

[] Air Fresheners

[]Hairsprays

[]Automotive Windshield Washer Fluids

[] Hair Mousses

[]Bathroom and Tile Cleaners

[]Hair Styling Gels

[] Carburetor and Choke Cleaners

[] Household Adhesives

[] Charcoal Lighter Materials

[] Insecticides

[] Cooking Sprays (Aerosols)

[] Laundry Prewash

[] Dusting Aids

[] Laundry Starch Products

[] Engine Degreasers

[] Nail Polish Removers

[] Fabric Protectants

[] Oven Cleaners

[] Floor Polishes/Waxes

[] Shaving Creams

[] Furniture Maintenance Products (Aerosols)

[] Underarm Antiperspirants (Aerosols)

[] General Purpose Cleaners

[] Underarm Deodorants (Aerosols)

[] Glass Cleaners

Description of Date-Coding System

Code Description _______________________________________________________________________________

_____________________________________________________________________________________________

Placement on Containers _________________________________________________________________________

Other Information ______________________________________________________________________________

Note: Any future changes to this code dating system requires notification of EPA within 30 days.

Name and Location of the Designated Recordkeeping Agent (See CFR Section 59.209(a)(1) and (a)(2).)

Same as Certifying Company Official (see above); and/or

Records also/instead being kept by the following agent(s)

Company________________________________________

Contact

______________________________________

Address _________________________________________City __________________ State _____ Zip _________

Phone Number ____/____/______ Fax Number ____/____/______

E-Mail Address ___________@_______.____

Initial Notification Report Form - Consumer Products

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